1. Suicidality and Self-Injury in Middle School SOS Signs of Suicide ® Program Screening for Mental Health, Inc.

2. “One young person contemplating suicide grips our hearts. Nine hundred thousand young people contemplating suicide grips our collective conscious.” -Charles Curie, Administrator, Substance Abuse and Mental Health Services Administration

3. Screening for Mental Health, Inc. 1991: Pioneered the concept of large scale mental health screening with National Depression Screening Day. 1991: Pioneered the concept of large scale mental health screening with National Depression Screening Day. SMH Programs include: SMH Programs include: SOS Signs of Suicide® High School Program SOS Signs of Suicide® High School Program National Alcohol Screening Day® National Alcohol Screening Day® CollegeResponse ® CollegeResponse ® WorkplaceResponse ® WorkplaceResponse ® HealthcareResponse ® HealthcareResponse ®

4. The Problem: Youth Suicide and Related Risk Factors

5. Prevalence of Suicide in Youth While child suicide is very uncommon, mortality from suicide increases steadily through the teens. While child suicide is very uncommon, mortality from suicide increases steadily through the teens. NIMH, In Harms Way, Suicide in America, 2003 NIMH, In Harms Way, Suicide in America, 2003 Suicide is the sixth leading cause of death among 5-14 year olds and the third leading cause of death among those 15-24. Suicide is the sixth leading cause of death among 5-14 year olds and the third leading cause of death among those 15-24. American Foundation for Suicide Prevention American Foundation for Suicide Prevention Adolescent suicidal behavior is deemed underreported because many deaths of this type are classified as unintentional or accidental. Adolescent suicidal behavior is deemed underreported because many deaths of this type are classified as unintentional or accidental. World Health Organization, 2000 World Health Organization, 2000 Over 90% of children and adolescents that die by suicide have a mental health disorder at the time of their death, most often depression. Over 90% of children and adolescents that die by suicide have a mental health disorder at the time of their death, most often depression.

6. Prevalence of Suicide-Related Phenomena in Middle School Age Group Seriously thought about killing themselves Seriously thought about killing themselves 18% of 6 th graders 18% of 6 th graders 19% of 7 th graders 19% of 7 th graders 24% of 8 th graders 24% of 8 th graders Made a plan about how to kill themselves Made a plan about how to kill themselves 11% of 6 th graders 11% of 6 th graders 12% of 7 th graders 12% of 7 th graders 12% of 8 th graders 12% of 8 th graders Made a suicide attempt Made a suicide attempt 7% of 6 th graders 7% of 6 th graders 9% of seventh graders 9% of seventh graders 11% of eighth graders 11% of eighth graders CDC Middle School Youth Risk Behavior Survey, 2003

7. What Are Risk Factors? Suicide is a complex behavior that is usually caused by a combination of risk factors in the context of negative life eventsSuicide is a complex behavior that is usually caused by a combination of risk factors in the context of negative life events A risk factor is anything that increases the likelihood that persons will harm themselves.A risk factor is anything that increases the likelihood that persons will harm themselves. Risk factors are not necessarily causes.Risk factors are not necessarily causes. The first step in preventing suicide is to identify and understand the risk factors.The first step in preventing suicide is to identify and understand the risk factors. -Adapted from the National Youth Violence Prevention Resource Center

8. SUICIDE: A MULTI-FACTORIAL EVENT Neurobiology Severe Medical Illness Impulsiveness Access To Weapons Hopelessness Life Stressors Family History Suicidal Behavior Personality Disorder/Traits Psychiatric Illness Co-morbidity Psychodynamics/ Psychological Vulnerability Substance Use/Abuse Suicide

9. Depression and Youth In 2004, 9% of adolescents aged 12 to 17 (an estimated 2.2 million adolescents) experienced at least one major depressive episode in the past year In 2004, 9% of adolescents aged 12 to 17 (an estimated 2.2 million adolescents) experienced at least one major depressive episode in the past year -SAMHSA, 2005 In children and adolescents, an untreated depressive episode may last between 7 to 9 months (Birmaher et al., 1996a, 1996b ) —potentially, an entire academic year! In children and adolescents, an untreated depressive episode may last between 7 to 9 months (Birmaher et al., 1996a, 1996b ) —potentially, an entire academic year! Depression has been linked to suicide, poor school performance, substance abuse, running away, and feelings of worthlessness and hopelessness Depression has been linked to suicide, poor school performance, substance abuse, running away, and feelings of worthlessness and hopelessness -National Institute for Mental Health, 2005

10. Symptoms of Adolescent Depression Frequent sadness, tearfulness, crying Frequent sadness, tearfulness, crying Hopelessness Hopelessness Decreased interest in activities; or inability to enjoy previously favorite activities Decreased interest in activities; or inability to enjoy previously favorite activities Persistent boredom; low energy Persistent boredom; low energy Social isolation, poor communication Social isolation, poor communication Low self esteem and guilt Low self esteem and guilt Extreme sensitivity to rejection or failure Extreme sensitivity to rejection or failure

11. Symptoms of Adolescent Depression (cont.) Increased irritability, anger, or hostility Increased irritability, anger, or hostility Difficulty with relationships Difficulty with relationships Frequent complaints of physical illnesses such as headaches and stomachaches Frequent complaints of physical illnesses such as headaches and stomachaches Frequent absences from school or poor performance in school Frequent absences from school or poor performance in school Poor concentration Poor concentration A major change in eating and/or sleeping patterns A major change in eating and/or sleeping patterns Talk of or efforts to run away from home Talk of or efforts to run away from home Thoughts or expressions of suicide or self destructive behavior Thoughts or expressions of suicide or self destructive behavior - AACAP, The Depressed Child

12. Signs of Suicide Talking, reading, or writing about suicide or death (including online communication) Talking, reading, or writing about suicide or death (including online communication) Talking about feeling worthless or hopeless Talking about feeling worthless or hopeless Saying things like “I wish I were dead.” Saying things like “I wish I were dead.” Visiting or calling people to say goodbye. Visiting or calling people to say goodbye. Giving things away. Giving things away. A sudden interest in drinking alcohol. A sudden interest in drinking alcohol. Purposefully putting oneself in danger. Purposefully putting oneself in danger. Obsessed with death, violence, and guns or knives. Obsessed with death, violence, and guns or knives. Previous suicidal thoughts or attempts. Previous suicidal thoughts or attempts. -http://pbskids.org/itsmylife

13. Suicidality and Substance Abuse Youths aged 12-17 who reported past year alcohol use (19.6%) were more likely than youths who did not use alcohol (8.6%) to be at risk for suicide. Youths aged 12-17 who reported past year alcohol use (19.6%) were more likely than youths who did not use alcohol (8.6%) to be at risk for suicide. SAMHSA, NHSDA Report, Substance use and the Risk of Suicide Among Youths, 2002 SAMHSA, NHSDA Report, Substance use and the Risk of Suicide Among Youths, 2002 1/3 to ½ of teenagers were under the influence of drugs or alcohol shortly before they killed themselves. 1/3 to ½ of teenagers were under the influence of drugs or alcohol shortly before they killed themselves. National Strategy for Suicide Prevention, DHHS National Strategy for Suicide Prevention, DHHS

14. Self-injury in Youth In the pediatric population, self-injury is defined as deliberate non-lethal harming of oneself In the pediatric population, self-injury is defined as deliberate non-lethal harming of oneself Self-injury is a maladaptive coping skill employed by youth experiencing painful emotions Self-injury is a maladaptive coping skill employed by youth experiencing painful emotions Is generally NOT an attempt to die by suicide. Is generally NOT an attempt to die by suicide. Between 150,000 and 360,000 adolescents in the U.S. self-injure Between 150,000 and 360,000 adolescents in the U.S. self-injure Walsh, Lieberman, 2004. Walsh, Lieberman, 2004.

15. Self-injury Comes in Several Forms Behaviors include: Behaviors include: Cutting – the most common form Cutting – the most common form Burning Burning Hitting Hitting Poking Poking Picking Picking Hair pulling Hair pulling Putting oneself in harms way Putting oneself in harms way Head banging Head banging

16. Relationship Between Suicide and Self-injury Death can occur, even if unintentionally Death can occur, even if unintentionally Those who self-injure may become suicidal in the future. Those who self-injure may become suicidal in the future. The student is experiencing a mental health disorder that should be treated professionally and stands the best chance of recovery if caught early. The student is experiencing a mental health disorder that should be treated professionally and stands the best chance of recovery if caught early. If handled inappropriately or not at all, there is a potential for contagion. If handled inappropriately or not at all, there is a potential for contagion.

17. Why Focus on Youth Prevention Many adult mental disorders have related antecedent problems in childhood Many adult mental disorders have related antecedent problems in childhood Children who first become depressed before puberty are at risk for some form of mental disorder in adulthood Children who first become depressed before puberty are at risk for some form of mental disorder in adulthood Suicide rates increase dramatically from early adolescence to young adulthood Suicide rates increase dramatically from early adolescence to young adulthood A previous suicide attempt is the leading risk factor for adult suicide A previous suicide attempt is the leading risk factor for adult suicide Introducing prevention early may help promote prevention throughout the lifecycle Introducing prevention early may help promote prevention throughout the lifecycle NIMH, 2005 NIMH, 2005

18. Developmental Stages of Younger Children Early adolescence is a time of emotional transition when individuals transfer their sense of interpersonal closeness from parents to peers. Early adolescence is a time of emotional transition when individuals transfer their sense of interpersonal closeness from parents to peers. Rothbaum et. al., Child Development, 2000 Rothbaum et. al., Child Development, 2000 Due to this transition, addressing the peer group is developmentally appropriate for those youth who have begun to confide in friends. Due to this transition, addressing the peer group is developmentally appropriate for those youth who have begun to confide in friends. Since younger students are more apt to share concerns with adults it is also important to encourage help- seeking from adults. Since younger students are more apt to share concerns with adults it is also important to encourage help- seeking from adults. In other words, you have to address both the role of peers and the role of adults. In other words, you have to address both the role of peers and the role of adults.

19. Adolescent Cognition Transition from the period of concrete operations (7-11 years) to period of formal operations (11-15 years) Transition from the period of concrete operations (7-11 years) to period of formal operations (11-15 years) Concrete thinking and problem-solving– performed in the presence of the objects thought about. Concrete thinking and problem-solving– performed in the presence of the objects thought about. Begins to reason logically and organize thoughts coherently. However, they can only think about actual physical objects, they cannot handle abstract reasoning Begins to reason logically and organize thoughts coherently. However, they can only think about actual physical objects, they cannot handle abstract reasoning Period of formal operations – Less tied to concrete reality Period of formal operations – Less tied to concrete reality Thought becomes more abstract, incorporating the principals of formal logic. Includes the ability to formulate hypotheses, think abstractly, reason. Thought becomes more abstract, incorporating the principals of formal logic. Includes the ability to formulate hypotheses, think abstractly, reason. Due to this shift – a middle school program must include materials that foster both Due to this shift – a middle school program must include materials that foster both

20. Integrated Prevention Strategies Integrated prevention strategies that address multiple associated factors are likely to be more effective in reducing suicidal behavior that programs that focus on a single risk factor. Integrated prevention strategies that address multiple associated factors are likely to be more effective in reducing suicidal behavior that programs that focus on a single risk factor. Grunbaum et al., Surveillance Summaries, 2004 Grunbaum et al., Surveillance Summaries, 2004 Risk factors for youth include: Risk factors for youth include: Depression Depression Conduct disorder Conduct disorder Suicidal ideation Suicidal ideation Alcohol use Alcohol use Self-injury Self-injury

21. The SOS Middle School Program

22. SOS Middle School Program Components Video/DVD – “SOS: Get Into the ACT” with Discussion Guide Video/DVD – “SOS: Get Into the ACT” with Discussion Guide Posters Posters Stickers -- “ACT” Stickers -- “ACT” Parent newsletter Parent newsletter Student newsletter Student newsletter Classroom Games Classroom Games Self-injury packet Self-injury packet Procedure Manual Procedure Manual Screening Forms for staff use Screening Forms for staff use

23. SOS Middle School Video/DVD With Discussion Guide The SOS: Get Into The Act video is the main teaching tool of the middle school program. The SOS: Get Into The Act video is the main teaching tool of the middle school program. Help students recognize the signs of suicide, depression and self-injury in a friend or within themselves and respond to them as they would in any type of health emergency. Help students recognize the signs of suicide, depression and self-injury in a friend or within themselves and respond to them as they would in any type of health emergency. Aim is to create a supportive and responsive atmosphere for those youth who may be at-risk for depression, suicide, or self-injury by empowering them to know how to recognize the warning signs and seek help. Aim is to create a supportive and responsive atmosphere for those youth who may be at-risk for depression, suicide, or self-injury by empowering them to know how to recognize the warning signs and seek help.

24. Action Message -- ACT A cknowledge: Acknowledge that your friend has a problem and it is serious A cknowledge: Acknowledge that your friend has a problem and it is serious C are: Let the person know you are concerned and want to help C are: Let the person know you are concerned and want to help T ell: Tell a trusted adult T ell: Tell a trusted adult

25. The ACT Message The message is primarily directed to peers to encourage them to help a friend but it emphasizes the need to tell a trusted adult The message is primarily directed to peers to encourage them to help a friend but it emphasizes the need to tell a trusted adult ACT can be generalized to use with any social problem ACT can be generalized to use with any social problem

26. Goals of the Program Decrease the incidence of self-injury, suicide attempts, unrecognized depression, and the number of youth who die by suicide Decrease the incidence of self-injury, suicide attempts, unrecognized depression, and the number of youth who die by suicide Encourage individual help seeking, as well as help seeking on behalf of a friend Encourage individual help seeking, as well as help seeking on behalf of a friend Increase knowledge and adaptive attitudes about depression, suicidality, and self-injury Increase knowledge and adaptive attitudes about depression, suicidality, and self-injury Reduce stigma associated with mental health problems by communicating that these problems are treatable Reduce stigma associated with mental health problems by communicating that these problems are treatable

27. Student Materials Student newsletter Student newsletter ACT stickers promote peer-to-peer communication by making the ACT message popular, personal and powerful. ACT stickers promote peer-to-peer communication by making the ACT message popular, personal and powerful. ACT posters to reinforce the ACT message ACT posters to reinforce the ACT message

28. Interactive Classroom Games Classroom games serve as a way of increasing both knowledge and skills in students Classroom games serve as a way of increasing both knowledge and skills in students Games that have learning complexity and are successfully infused into the curriculum are an effective strategy to move the knowledge and skills students receive into long-term memory and result in positive behaviors Games that have learning complexity and are successfully infused into the curriculum are an effective strategy to move the knowledge and skills students receive into long-term memory and result in positive behaviors

29. Parent Materials Parent materials are provided to actively engage parents in a school’s prevention efforts, to: Parent materials are provided to actively engage parents in a school’s prevention efforts, to: Gain their support Gain their support Provide information about mental health resources available in the school and community Provide information about mental health resources available in the school and community Encourage parents to discuss the problems of depression, suicide, and self-injury with their children. Encourage parents to discuss the problems of depression, suicide, and self-injury with their children. By raising awareness, schools can partner with parents to watch for the signs of problems in their children and instill confidence in parents to seek help for their children if necessary. By raising awareness, schools can partner with parents to watch for the signs of problems in their children and instill confidence in parents to seek help for their children if necessary.

30. Staff Materials Staff in-service lecture Staff in-service lecture Guidelines for teachers and school clinicians for responding to youth who self-injure (Self-injury Packet) Guidelines for teachers and school clinicians for responding to youth who self-injure (Self-injury Packet) Parent Newsletter for staff who are parents Parent Newsletter for staff who are parents Center for Epidemiological Studies Depression Scale for Children (CES-DC) for school staff to use with individual students seeking help Center for Epidemiological Studies Depression Scale for Children (CES-DC) for school staff to use with individual students seeking help

31. Encourages student help-seeking Encourages student help-seeking Encourages collaboration with local mental health facilities and individual professionals for increased access to treatment Encourages collaboration with local mental health facilities and individual professionals for increased access to treatment Accessing Treatment Based on the SOS: Get Into the ACT Program, I feel…  I need to talk to someone about myself or a friend.  I do not need to talk to someone about myself or a friend. Name (Print)______________________________________________ Teacher_________________________________________________ If you wish to speak with someone, you will be contacted (indicate time frame). If you need to speak with someone sooner, please ask for help immediately.

32. Implementation Overview School personnel implement the program with materials provided School personnel implement the program with materials provided Can be implemented in one or two classroom periods Can be implemented in one or two classroom periods Students view and discuss video in classroom. Students view and discuss video in classroom. Students are assigned Student Newsletter to read Students are assigned Student Newsletter to read Students participate in classroom game Students participate in classroom game

33. Implementation Overview (cont.) Entire student body or a select portion of student body may participate in the program. Entire student body or a select portion of student body may participate in the program. Parent newsletter assists in the identification of depression, self-injury, and suicidality and helps initiate family discussion Parent newsletter assists in the identification of depression, self-injury, and suicidality and helps initiate family discussion Active or passive parental permission Active or passive parental permission Parent Night Parent Night Staff Training Staff Training

34. Staff Training Training faculty and staff is universally advocated and essential to a suicide prevention program. Training faculty and staff is universally advocated and essential to a suicide prevention program. Research indicates that training faculty and staff can produce positive effects on an educator’s knowledge, attitudes and referral practice. Research indicates that training faculty and staff can produce positive effects on an educator’s knowledge, attitudes and referral practice. Smith, T & Smith V., Lazear, K, Roggenbaum, S., & Doan, J., 2003. Smith, T & Smith V., Lazear, K, Roggenbaum, S., & Doan, J., 2003.

35. Staff Training (cont.) Schools must prepare staff as students may disclose to any adult. Schools must prepare staff as students may disclose to any adult. Train to increase school staff’s knowledge about: Train to increase school staff’s knowledge about: SOS program: why, when, where, how SOS program: why, when, where, how Warning signs Warning signs School and community based mental health resources School and community based mental health resources School protocol for providing help for at-risk youth School protocol for providing help for at-risk youth

36. Staff Training Suggestions Show the “Get Into the ACT” video and facilitate a discussion Show the “Get Into the ACT” video and facilitate a discussion Review the signs of suicide and depression. Review the signs of suicide and depression. Answer questions, dispel myths Answer questions, dispel myths Review the school policy for handling students who disclose suicidal intent Review the school policy for handling students who disclose suicidal intent Review school and community resources. Review school and community resources. Distribute protocol for what to do when approached by students asking for help Distribute protocol for what to do when approached by students asking for help “Feed them and they will come.” “Feed them and they will come.”

37. Parents as Partners Studies have shown that a many as 86% of parents were unaware of their child’s suicidal behavior. Studies have shown that a many as 86% of parents were unaware of their child’s suicidal behavior. The percentage of parents who are involved in a student’s activities is very small. The percentage of parents who are involved in a student’s activities is very small. Smith, T & Smith V., Lazear, K, Roggenbaum, S., & Doan, J., 2003. Smith, T & Smith V., Lazear, K, Roggenbaum, S., & Doan, J., 2003.

38. Engaging Parents/Guardians Sends parents a letter stating the goals of the program (template provided), referral resources, and Parent Newsletter. Sends parents a letter stating the goals of the program (template provided), referral resources, and Parent Newsletter. Decide between active and passive consent. Decide between active and passive consent. Combine permission form collection with other activities (sports forms, next year’s schedule). Combine permission form collection with other activities (sports forms, next year’s schedule). Host a parent night event: Host a parent night event: Show video, facilitate discussion Show video, facilitate discussion Distribute the Parent Newsletter Distribute the Parent Newsletter Answer questions, dispel myths Answer questions, dispel myths Review warning signs, protective factors, and limiting access to lethal means Review warning signs, protective factors, and limiting access to lethal means Provide referral resources in the school and community Provide referral resources in the school and community

39. Plan for Referrals Contact local mental health facilities and advise them of your program dates and times Contact local mental health facilities and advise them of your program dates and times Verify referral procedures, wait lists, insurance details, etc. Verify referral procedures, wait lists, insurance details, etc. Create a Referral Resource list or send with parent packet Create a Referral Resource list or send with parent packet Use SAMHSA’s Find Treatment Locator to identify additional referral resources Use SAMHSA’s Find Treatment Locator to identify additional referral resources

40. SAMHSA’s Find Treatment Locator http://www.mentalhealth.samhsa.gov/DATABASES/DEFAULT.ASP

41. Help-Seeking and Follow Up Use Response Card Use Response Card Brainstorm ways to encourage students to seek help, involve students in this planning Brainstorm ways to encourage students to seek help, involve students in this planning Respond to requests for help Respond to requests for help Set expectations about when follow-up can be expected Set expectations about when follow-up can be expected Provide referral information Provide referral information Track students using the Student Follow-Up Form Track students using the Student Follow-Up Form Involve peer leaders in encouraging help seeking Involve peer leaders in encouraging help seeking

42. Other Suggestions Demonstrate the program to administration to get their support Demonstrate the program to administration to get their support Start small, pilot test Start small, pilot test Involve students in the program planning Involve students in the program planning

43. Get Teacher Buy-In Involve teachers from the start Involve teachers from the start Change requires growth Change requires growth Change is a process Change is a process Speak to teachers’ needs Speak to teachers’ needs Speak their language Speak their language Keep change small and simple Keep change small and simple Everyone is different (process of change) Everyone is different (process of change) Change is reversible Change is reversible Maintain change Maintain change Minimize the risks Minimize the risks -Prevention that Works! Knowles, Cynthia, 2001.

44. Why Partner? If a school does not have adequate staffIf a school does not have adequate staff Students may feel more comfortable speaking with an outsiderStudents may feel more comfortable speaking with an outsider As an introduction to community-based mental health resourcesAs an introduction to community-based mental health resources Enhance referral network for the schoolEnhance referral network for the school “Allowing these agencies into the building educates and familiarizes students with their services and how to access them.”

45. Common Objections “Suicide is not a problem in our school.” “Suicide is not a problem in our school.” “Schools are not appropriate for suicide prevention programs.” “Schools are not appropriate for suicide prevention programs.” “The program may introduce the idea to students.” “The program may introduce the idea to students.” “I don’t have enough staff or time.” “I don’t have enough staff or time.” “We have problems making referrals.” “We have problems making referrals.” “I don’t agree with labeling youth.” “I don’t agree with labeling youth.” “We already have a suicide prevention program.” “We already have a suicide prevention program.”

46. Responses to Common Objections No school is immune to adolescent suicide. No school is immune to adolescent suicide. Depression has been linked to poor school performance, substance abuse, running away, and feelings of worthlessness and hopelessness. Student problems with academics, peers, and others are more apt to be evident in schools. Depression has been linked to poor school performance, substance abuse, running away, and feelings of worthlessness and hopelessness. Student problems with academics, peers, and others are more apt to be evident in schools. The majority of parents are unaware of their child’s suicidality. The majority of parents are unaware of their child’s suicidality. Integrating the topics of depression and suicide in a health curriculum can reduce stigma associated with these problems and can create a supportive atmosphere in which at-risk youth may talk about their feelings and get the help that they need. Integrating the topics of depression and suicide in a health curriculum can reduce stigma associated with these problems and can create a supportive atmosphere in which at-risk youth may talk about their feelings and get the help that they need. The program can be used flexibly using existing resources and partnering with community providers. The program can be used flexibly using existing resources and partnering with community providers. Identifying needs can justify funding. Share resources within school districts. Establish relationship with existing providers. Identifying needs can justify funding. Share resources within school districts. Establish relationship with existing providers. Implementing the SOS program does not result in diagnosis. Decisions about diagnosis and treatment are made between a doctor and a patient, and, in the case of minors, the parent/guardian(s). Implementing the SOS program does not result in diagnosis. Decisions about diagnosis and treatment are made between a doctor and a patient, and, in the case of minors, the parent/guardian(s).

47. Clinical Advisors William Beardslee, MD William Beardslee, MD Children’s Hospital, Boston, MA Children’s Hospital, Boston, MA Jon Hisgen, MS, CHES Jon Hisgen, MS, CHES Wisconsin Department of Public Instruction, Madison, WI Wisconsin Department of Public Instruction, Madison, WI Cheryl King, PhD Cheryl King, PhD University of Michigan Depression Center, Ann Arbor, MI University of Michigan Depression Center, Ann Arbor, MI Rich Lieberman, NCSP Rich Lieberman, NCSP Los Angeles Unified School District, Los Angeles, CA Los Angeles Unified School District, Los Angeles, CA Scott Poland, NCSP Scott Poland, NCSP NOVA Southeastern University, Ft. Lauderdale, FL NOVA Southeastern University, Ft. Lauderdale, FL Jefferson Prince, MD Jefferson Prince, MD Massachusetts General Hospital, Boston, MA Massachusetts General Hospital, Boston, MA Barent (Barry) Walsh, PhD Barent (Barry) Walsh, PhD The Bridge of Central MA, Worcester, MA The Bridge of Central MA, Worcester, MA

48. School Based Professionals Cynthia Bucken, Nipmuc Regional Middle/High School, Upton, MA Cynthia Bucken, Nipmuc Regional Middle/High School, Upton, MA Ellen Courshene, Wellesley Middle School, Wellesley, MA Ellen Courshene, Wellesley Middle School, Wellesley, MA Laurie Curley, Ph.D., JFK Middle School, Hudson, MA Laurie Curley, Ph.D., JFK Middle School, Hudson, MA Deborah Hardy, Ed.D., Ed.M., M.S., Irvington Middle School, Irvington, NY Deborah Hardy, Ed.D., Ed.M., M.S., Irvington Middle School, Irvington, NY Kay Hurley, Sarah W. Gibbons Middle School, Westborough, MA Kay Hurley, Sarah W. Gibbons Middle School, Westborough, MA Karen Ingerman, Remington Middle School, Franklin, MA Karen Ingerman, Remington Middle School, Franklin, MA Joann Kenney, Dover Sherborn Regional Middle School, Dover, MA Joann Kenney, Dover Sherborn Regional Middle School, Dover, MA Tara Manke, Ph.D., Stacy Middle School and Middle School East, Milford, MA Tara Manke, Ph.D., Stacy Middle School and Middle School East, Milford, MA Elaine Mitsocke, Robert H. Adams Middle School, Holliston, MA Elaine Mitsocke, Robert H. Adams Middle School, Holliston, MA Julie Phipps, Robert E. Melican Middle School, Northborough, MA Julie Phipps, Robert E. Melican Middle School, Northborough, MA

49. For more information about the SOS Middle School or the SOS High School program, please reach us at: 781-239-0071 sosinfo@MentalHealthScreening.org Or visit: www.MentalHealthScreening.org/schools @MentalHealthScreening.org@MentalHealthScreening.org Screening for Mental Health, Inc. One Washington Street, Suite 304 Wellesley Hills, MA 02481 Phone: 781.239.0071 Fax: 781.431.7447 www.mentalhealthscreening.org